Department of Internal Medicine, University of Cincinnati Medical Center, USA.
Providence Health & Services of Oregon and Southwest Washington, Division of Pulmonary and Critical Care Medicine, USA.
Respir Med. 2018 Jul;140:71-76. doi: 10.1016/j.rmed.2018.05.019. Epub 2018 May 25.
Transbronchial lung cryobiopsy (TBLC) has become a popular option for tissue diagnosis of interstitial lung disease (ILD), however reports vary regarding the safety of this procedure. Herein, we evaluate the safety of transbronchial cryobiopsy in hospitalized patients, comparing adverse events to outpatient procedures.
This is a single center, retrospective chart review of all TBLC performed for suspected ILD between November 2013 and March 2017. Biopsies were performed by a board certified interventional pulmonologist or interventional pulmonology fellow using a two-scope technique.
One hundred fifty-nine cryobiopsies were performed for the diagnosis of ILD. Rates of adverse events are as follows: pneumothorax 11%, persistent air leak 1.3%, moderate-severe bleeding 3.8%, ICU transfer within 48 h 3.1%, and all cause 30-day mortality 1.9%. No deaths were attributed to the procedure. Comparing adverse events between hospitalized patients and outpatients, rates of pneumothorax were 24% vs 9.9%, persistent air leak 5.9% vs 0.7%, ICU transfer 12% vs 2.1%, and 30-day mortality 5.9% vs 1.4%. However, no differences were statistically significant.
Practitioners should recognize that while cryobiopsies are a high-yield, safe, and cost-effective alternative to surgical lung biopsy, not all procedures carry the same risk profiles. Hospitalized patients may have a greater propensity for pneumothorax, persistent air leak, transfer to the ICU, and 30-day mortality.
经支气管肺冷冻活检（TBLC）已成为间质性肺疾病（ILD）组织诊断的热门选择，但关于该程序的安全性的报告却各不相同。在此，我们评估了住院患者经支气管冷冻活检的安全性，并将不良事件与门诊手术进行了比较。
这是一项回顾性的单中心图表研究，纳入了 2013 年 11 月至 2017 年 3 月间所有疑似 ILD 患者进行的经支气管冷冻活检。活检由经 board 认证的介入肺科医生或介入肺科研究员使用双镜技术进行。
共进行了 159 例冷冻活检以诊断 ILD。不良事件的发生率如下：气胸 11%，持续性空气漏 1.3%，中重度出血 3.8%，48 小时内转入 ICU 3.1%，以及所有原因 30 天死亡率 1.9%。无死亡归因于该操作。将住院患者和门诊患者的不良事件进行比较，气胸的发生率分别为 24%和 9.9%，持续性空气漏分别为 5.9%和 0.7%，转入 ICU 分别为 12%和 2.1%，以及 30 天死亡率分别为 5.9%和 1.4%。但是，差异没有统计学意义。
从业者应认识到，尽管冷冻活检是一种高收益、安全且具有成本效益的手术肺活检替代方法，但并非所有操作都具有相同的风险特征。住院患者可能更易发生气胸、持续性空气漏、转入 ICU 和 30 天死亡率。
